HomeMy WebLinkAboutMortgage_Hancock�.^•n,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
1 FOR DEDUCTION FROM ASSESSED VALUATION ��.
� State Fortn a3709 (R71 / 6-09) '�
��� � PrescnDed by DeparVnent W Local Govemmen� Finance �� } �
Fi'te A�3t1f �
lNSTRUCTIONS:
To be filetl in person or by mail.
Filinq Dates: 1) Real Property: Must be completed and dated in the calandar yearlor which fhe detluction is soughf.
Musf 6e filed wifh Ne CountyAudimr orCounry Recnrder o/1he counry where the property is located
on or be/ore January 5 of the immediately succeeding calendar year.
2J Mobile /Manu/actured Homes no( assessed as Real PropeRy: Must file wi[h the CountyAuditor o7fhe
county where fhe pioperty is lowred dunng fhe (weNe (12J months 6efore March 31 0( each year the
deduction is sought.
See raverse side !or additional instrucfions and qualificafions.
Appticant (owner or convact ouyer - see restrictions m reversa side)
Daniel J. and Amanda B. Hancock
iaring oistria l Kay nu
�l/
���
assessea vaNe a real v�aeM1r az o�
IAarrh 1. artentyear
11 no, what is Ns / �er ezad share o1 interest?
wnentyear
�l name on recoN is OiEerent Uan Uai o( aDGbw��• iMiw�e beb�r.
rtwrtgagee w contract seDer
AtlEress of rtwrtgagee
owner or tqltler ot mwc9age
AEtlress o( auiqnee (number and sneet crty. sfare, aiM ZIP cadej
Does appliwnt own pmperty in anY oNer If yes. what
counryinlnCUre? � _. � _.
If ovmed wiN someone oNer
F� �"�" 3 2010
ounry Autlitor
` CouNV�.i�rder
v • � f'
alo�i0�1 cduNTY A.UOITOR
Record number
ao� o
btadness unpaid as of Is
�./'� le�
W �
spouse, inCicate wiih whom
Yes LI No
Is Na pmperty in Question: MnuaDy AssesseE
❑ Real Property � MnuallyASSessetl
requested an property
COUNTY AUDITOR
Oetluctian approved in Ihe amount oh.
20 20 20 20 20 20 20
Sgna:ure oi GounryAUCrtor I Counry I Date (monN, tlay, yea�
I I We ceNfy under Ne penalry of perjury that Ne above and foregoing information is we and correci and that the applicant is a resident of Indiana and
owner / conVac� buyer of th aforementioned property on date appli 'on is fiied.
�Signa (own 7W1 name) � / Date (monN. tl y. yeah
(-OT /�' Oi� c�0 a,�/ C�
Fu0 revEent aEdre t liwnt (nu.. r . ciry, sfa(e, and ZIP code) '
Person authorized by duy executM Power of Anomey or by IC 61.7-12-0.� Date (month, day. yea�
ACtlress at auttwf¢ed person (number aiM s[reef, dfy, state, antl ZIPmCe)